RESUMEN

PURPOSE: Fatigue is one of the most common and distressing symptoms experienced by cancer survivors. Understanding fatigue trajectories from pre- to post-diagnosis could inform fatigue prevention and management strategies. METHODS: We used the Surveillance, Epidemiology and End Results Medicare Health Outcomes Survey (SEER-MHOS) linked data resource to characterize fatigue trajectories and their predictors 1214 older adult survivors of breast, colorectal, or prostate cancer. Fatigue was measured prior to the cancer diagnosis (T0) and at two timepoints after diagnosis (T1: mean = 20 months and T2: mean = 39 months post-diagnosis). Latent growth curve modeling and mixed effects models for repeated measurements were used to investigate fatigue experiences before and after a cancer diagnosis. RESULTS: Overall, mean fatigue T-scores declined (T0 = 50, T1 = 46, and T2 = 45) indicating worsening fatigue over time. Four latent trajectory subgroups were identified: severe fatigue worsening over time (8.2% of sample), severe fatigue persisting over time (14.4%), no fatigue pre-diagnosis and mild fatigue post-diagnosis (44.4%), and not fatigued (33%). Age, cancer stage, comorbidities, and depressed mood predicted membership in the two trajectory groups experiencing severe fatigue that persisted or that worsened post-diagnosis. Older age, advanced cancer stage at diagnosis, and depressed mood were significantly associated with worsening fatigue from T1 to T2 (all p < 0.0001). CONCLUSIONS: Evaluating cancer patients for depressive symptoms and considering prior fatigue levels, age, comorbid conditions, and cancer stage may help providers anticipate fatigue trajectories and implement pre-emptive strategies to lessen fatigue impact.

Asunto(s)

Neoplasias de la Mama , Supervivientes de Cáncer , Neoplasias Colorrectales , Neoplasias de la Próstata , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias Colorrectales/epidemiología , Fatiga/epidemiología , Fatiga/etiología , Humanos , Masculino , Medicare , Neoplasias de la Próstata/epidemiología , Sobrevivientes , Estados Unidos/epidemiología

RESUMEN

Objectives: Expectation can significantly modulate pain and treatment effects. This study aims to investigate if boosting patients' expectancy can enhance the treatment of knee osteoarthritis (KOA), and its underlying brain mechanism. Methods: Seventy-four KOA patients were recruited and randomized to three groups: boosted acupuncture (with a manipulation to enhance expectation), standard acupuncture, or treatment as usual (TAU). Each patient underwent six treatments before being debriefed, and four additional treatments after being debriefed. The fMRI scans were applied during the first and sixth treatment sessions. Results: We found significantly decreased knee pain in the boosted acupuncture group compared to the standard acupuncture or TAU groups after both six and ten treatments. Resting state functional connectivity (rsFC) analyses using the nucleus accumbens (NAc) as the seed showed rsFC increases between the NAc and the medial prefrontal cortex (MPFC)/rostral anterior cingulate cortex (rACC) and dorsolateral prefrontal cortex in the boosted group as compared to the standard acupuncture group after multiple treatments. Expectancy scores after the first treatment were significantly associated with increased NAc-rACC/MPFC rsFC and decreased knee pain following treatment. Conclusions: Our study provides a novel method and mechanism for boosting the treatment of pain in patients with KOA. Our findings may shed light on enhancing outcomes of pharmacological and integrative medicines in clinical settings.

Asunto(s)

Terapia por Acupuntura/métodos , Encéfalo/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Osteoartritis de la Rodilla , Umbral del Dolor/psicología , Adulto , Anciano , Análisis de Varianza , Femenino , Humanos , Hiperalgesia/rehabilitación , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/psicología , Osteoartritis de la Rodilla/terapia , Oxígeno/sangre , Dolor/etiología , Dolor/psicología , Dimensión del Dolor , Estimulación Física/efectos adversos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

There are multiple ways in which working memory can influence selective attention. Aside from the content-specific effects of working memory on selective attention, whereby attention is more likely to be directed towards information that matches the contents of working memory, the mere level of load on working memory has also been shown to have an effect on selective attention. Specifically, high load on working memory is associated with increased processing of irrelevant information. In most demonstrations of the effect to-date, this has led to impaired target performance, leaving open the possibility that the effect partly reflects an increase in general task difficulty under high load. Here we show that working memory load can result in a performance gain when processing of distracting information aids target performance. The facilitation in the detection of a low-contrast Gabor stimulus in the presence of collinear flanking Gabors was greater when load on a concurrent working memory task was high, compared to low. This finding suggests that working memory can interact with selective attention at an early stage in visual processing.